Objective: : Stent-assisted coil embolization (SAC) has been increasingly used to treat various types of intracranial aneurysms. Delayed thromboembolic complications are major concerns regarding this procedure, so dual antiplatelet therapy with aspirin and clopidogrel is needed. However, clinicians vary the duration of dual antiplatelet therapy after SAC, and no randomized study has been performed. This study aims to compare the safety and efficacy of long-term (12 months) dual antiplatelet therapy and shortterm dual antiplatelet therapy (6 months) after SAC for patients with unruptured intracranial aneurysms (UIAs). Methods: : This is a prospective, randomized and multicenter trial to investigate the optimal duration of dual antiplatelet therapy after SAC in patients with UIAs. Subjects will receive dual antiplatelet therapy for 6 months (short-term group) or 12 months (longterm group) after SAC. The primary endpoint is the assessment of thromboembolic complications between 1 and 18 months after SAC. We will enroll 528 subjects (264 subjects in each group) and perform 1 : 1 randomization. This study will involve 14 topperforming, high-volume Korean institutions specializing in coil embolization. Results: : The trial will begin enrollment in 2022, and clinical data will be available after enrollment and follow-up. Conclusion : This article describes that the aim of this prospective randomized multicenter trial is to compare the effect of short-term (6 months) and long-term (12 months) dual antiplatelet therapy on UIAs in patients undergoing SAC, and to find the optimal duration.

PURPOSE: To evaluate superiority of a night float (NF) system in comparison to a traditional night on-call (NO) system for surgical residents at a single institution in terms of efficacy, safety, and satisfaction. METHODS: A NF system was implemented from March to September 2017 and big data analysis from electronic medical records was performed for all patients admitted for surgery or contacted from the emergency room (ER). Parameters including vital signs, mortality, and morbidity rates, as well as promptness of response to ER calls, were compared against a comparable period (March to September 2016) during which a NO system was in effect. A survey was also performed for physicians and nurses who had experienced both systems. RESULTS: A total of 150,000 clinical data were analyzed. Under the NO and NF systems, a total of 3,900 and 3,726 patients were admitted for surgery. Mortality rates were similar but postoperative bleeding was significantly higher in the NO system (0.5% vs. 0.2%, P = 0.031). From the 1,462 and 1,354 patients under the NO and NF systems respectively, that required surgical consultation from the ER, the time to response was significantly shorter in the NF system (54.5 ± 70.7 minutes vs. 66.8 ± 83.8 minutes, P < 0.001). Both physicians (90.4%) and nurses (91.4%) agreed that the NF system was more beneficial. CONCLUSION: This is the first report of a NF system using big data analysis in Korea, and potential benefits of this new system were observed in both ward and ER patient management.
Electronic Health Records ; Emergency Service, Hospital ; Hemorrhage ; Humans ; Internship and Residency ; Korea ; Medical Staff ; Mortality ; Statistics as Topic ; Vital Signs

OBJECTIVE: We investigated the impact of depressed mood (dysphoria) and loss of interest or pleasure (anhedonia)on the risk of dementia in cognitively-normal elderly individuals. METHODS: This study included 2,685 cognitively-normal elderly individuals who completed the baseline and 4-year follow-up assessments of the Korean Longitudinal Study on Cognitive Aging and Dementia. We ascertained the presence of dysphoria and anhedonia using the Mini International Neuropsychiatric Inventory. We defined subjective cognitive decline as the presence of subjective cognitive complaints without objective cognitive impairments. We analyzed the association of dysphoria and anhedonia with the risk of cognitive disorders using multinomial logistic regression analysis adjusted for age, sex, education, Cumulative Illness Rating Scale score, Apolipoprotein E genotype, and neuropsychological test performance. RESULTS: During the 4-year follow-up period, anhedonia was associated with an approximately twofold higher risk of mild cognitive impairment (OR=2.09, 95% CI=1.20–3.64, p=0.008) and fivefold higher risk of dementia (OR=5.07, 95% CI=1.44–17.92, p=0.012) but was not associated with the risk of subjective cognitive decline. In contrast, dysphoria was associated with an approximately twofold higher risk of subjective cognitive decline (OR=2.06, 95% CI=1.33–3.19, p=0.001) and 1.7-fold higher risk of mild cognitive impairment (OR=1.75, 95% CI=1.00–3.05, p=0.048) but was not associated with the risk of dementia. CONCLUSION: Anhedonia, but not dysphoria, is a risk factor of dementia in cognitively-normal elderly individuals.
Aged ; Anhedonia ; Apolipoproteins ; Cognition Disorders ; Cognitive Aging ; Cohort Studies ; Dementia ; Depression ; Education ; Follow-Up Studies ; Genotype ; Humans ; Logistic Models ; Longitudinal Studies ; Mild Cognitive Impairment ; Neuropsychological Tests ; Pleasure ; Prospective Studies ; Risk Factors

BACKGROUND: We evaluated the radiological and clinical results of reduction using a dynamic hip screw according to the grade of medial cortical support in patients with AO Foundation and Orthopaedic Trauma Association (AO/OTA) classification type 31-A2 pertrochanteric fractures. METHODS: We enrolled 100 patients with AO/OTA type 31-A2 fractures with displaced lesser trochanter fragments (length of the cortical area longer than 20 mm on the pelvis anteroposterior view). Patients with positive medial cortical support were assigned to group 1 (n = 28); neutral medial cortical support, group 2 (n = 42); and negative medial cortical support, group 3 (n = 30). Radiological evaluation was done by measuring the change in the femoral neck-shaft angle and sliding distance of the lag screw. Clinical outcomes of each group were compared by means of the walking ability score proposed by Ceder. RESULTS: Group 1 showed significantly less changes in the femoral neck-shaft angle and shorter sliding distance than groups 2 and 3. Group 2 showed significantly less changes in the femoral neck-shaft angle and shorter sliding distance than group 3. Group 1 showed significantly higher walking ability scores than group 3 (p = 0.00). The use of trochanter stabilizing plates or fixation using wires for posteromedial wall defect resulted in no significant changes in terms of the femoral neck-shaft angle or sliding distance. CONCLUSIONS: In the treatment of pertrochanteric fractures accompanied by posteromedial wall defect using a dynamic hip screw, reduction with negative cortical support should be avoided.
Classification ; Femur ; Hip* ; Humans ; Pelvis ; Walking

Since laparoscopic liver resection was first introduced in 2001, Korean surgeons have chosen a laparoscopic procedure as one of the treatment options for benign or malignant liver disease. We distributed and analyzed a nationwide questionnaire to members of the Korean Laparoscopic Liver Surgery Study Group (KLLSG) in order to evaluate the current status of laparoscopic liver resection in Korea. Questionnaires were sent to 24 centers of KLLSG. The questionnaire consisted of operative procedure, histological diagnosis of liver lesions, indications for resection, causes of conversion to open surgery, and postoperative outcomes. A laparoscopic liver resection was performed in 416 patients from 2001 to 2008. Of 416 patients, 59.6% had malignant tumors, and 40.4% had benign diseases. A total laparoscopic approach was performed in 88.7%. Anatomical laparoscopic liver resection was more commonly performed than non-anatomical resection (59.9% vs 40.1%). The anatomical laparoscopic liver resection procedures consisted of a left lateral sectionectomy (29.3%), left hemihepatectomy (19.2%), right hemihepatectomy (6%), right posterior sectionectomy (4.3%), central bisectionectomy (0.5%), and caudate lobectomy (0.5%). Laparoscopy-related serious complications occurred in 12 (2.8%) patients. The present study findings provide data in terms of indication, type and method of liver resection, and current status of laparoscopic liver resection in Korea.
*Hepatectomy/statistics & numerical data ; Humans ; *Laparoscopy/statistics & numerical data ; Liver/*surgery ; Liver Diseases/pathology/surgery ; Liver Neoplasms/pathology/surgery ; Postoperative Complications/epidemiology ; Questionnaires ; Republic of Korea

PURPOSE: The purpose of this study was to evaluate the early results of total hip arthroplasty (THA) performed using large diameter femoral head against with highly cross-linked polyethylene as a bearing surface in patients less than sixty years of age. MATERIALS AND METHODS: Seventy patients were enrolled and retrospectively reviewed. The mean age of patients at index surgery was 49 years and the mean follow-up period was 61 months. Clinical follow-up involved implementing the Harris hip score (HHS) and a radiographic evaluation that included linear radiolucency, osteolysis, and loosening. An annual wear rate was performed at 6 weeks; at 3, 6, and 12 months; and on a yearly basis thereafter. RESULTS: The average HHS at last follow-up was 94 (range: 82-98). Radiographically, no osteolysis in the pelvis or proximal femur was observed in any patient. No acetabular cup or femoral stem failed due to aseptic loosening. No eccentric wear was observed on any liner, and no liner fracture occurred. However, one patient experienced hip dislocation. The average femoral head penetration rate during the first postoperative year was 0.077+/-0.026 mm/year, and the average steady-state wear rate was 0.033+/-0.023 mm/year. CONCLUSION: THA with a large diameter femoral head of highly cross-linked polyethylene in patients younger than 60 years of age was found to produce results comparable to previous in vitro laboratory hip simulation studies. In particular, patient satisfaction was high due to no limitation in range of motion or hip posture during the early post-operative period. Longer-term follow-up is required to demonstrate the clinical benefits of this new material more comprehensively.
Arthroplasty ; Femur ; Follow-Up Studies ; Head ; Hip ; Hip Dislocation ; Humans ; Osteolysis ; Patient Satisfaction ; Pelvis ; Polyethylene ; Posture ; Range of Motion, Articular ; Retrospective Studies ; Tacrine ; Ursidae

PURPOSE: Liver regeneration is crucial following major liver resection or partial liver transplantation. The inhibition mechanism of regeneration is portal hypertension caused by excessive portal flow to the small liver. Portal hypertension can be controlled with terlipressin, an effective splanchnic vasoconstrictor. The purpose of this study was to investigate the effect of terlipressin on the portal pressure and liver regeneration in 90% hepatectomized rats. METHODS: Forty-eight male Sprague-Dawley (250 gm) rats were divided into three groups; Group N (n=16) underwent Sham operation, Group C (n=16) was injected with 0.1 mL saline after 90% hepatectomy, and Group T (n=16) was injected with 50microgram/kg terlipressin after 90% hepatectomy. To assess the liver regeneration response, the changes in proliferating cell nuclear antigen (PCNA) and tumor necrosis factor-alpha (TNFalpha) were monitored for 48 hours. RESULTS: The baseline portal pressures in Groups N, C, and T were 4.9, 12.4, and 14.1 mmHg (P<0.05). In Group T, the injection of terlipressin induced a significant reduction of the portal pressure (-30.2%, P<0.05). There was no difference in PCNA between Groups C and T. However, serum TNFalpha levels were significantly higher in Group T (248.4 pg/ mL) than Group C (52.3 pg/mL) 48 hours postoperatively (P<0.05). CONCLUSION: The control of portal pressure with the use of terlipressin was correlated with serum TNFalpha. These data provide evidence that the administration of terlipressin during the early postoperative period following major liver resection may have an attenuating effect on portal hypertension, which may also stimulate the initiation of the regenerative process.
Animals ; Hepatectomy ; Humans ; Hypertension, Portal ; Liver Regeneration* ; Liver Transplantation ; Liver* ; Male ; Portal Pressure* ; Postoperative Period ; Proliferating Cell Nuclear Antigen ; Rats* ; Rats, Sprague-Dawley ; Regeneration ; Tumor Necrosis Factor-alpha

BACKGROUND: The relative frequency and clinicopathologic characteristics of lymphomas vary according to geography and race. Data on the features of cutaneous lymphoma in Korea are limited. OBJECTIVE: The aim of this study was to document the relative occurrence, the clinical and histopathological features of cutaneous lymphomas in Korea. METHODS: The Korean Dermatopathology Research Group conducted a review of nationwide collection of 80 cutaneous lymphomas, diagnosed at 23 institutes over recent 3-year period. Clinical records and pathology slides of the patients were reviewed retrospectively. RESULTS AND CONCLUSION: Korea has a higher rate of T-cell lymphoma and NK/T cell lymphoma and a much lower rate of cutaneous B cell lymphoma. The relative frequency of the major diagnostic group according to WHO classification was as follows: mycosis fungoides/Sezary syndrome, 42.5%; anaplastic large cell lymphoma, 19%; nasal and nasal type NK/T cell lymphoma, 15%; subcutaneous panniculitis-like T cell lymphoma, 11%; peripheral T cell lymphoma, unspecified, 7.5%; follicular lymphoma, 3%; marginal zone lymphoma, 1%; angioimmunoblastic lymphadenopathy, 1%. Compared with Western countries, the rate of nasal and nasal-type NK/T cell lymphoma and subcutaneous panniculitis-like T cell lymphoma were much higher. Therefore, The EORTC classification is not effective in dealing with Korean cases of cutaneous lymphoma. We consider the principles of the WHO classification are applicable to the Korean cases of cutaneous lymphoma.
Academies and Institutes ; Classification ; Continental Population Groups ; Geography ; Humans ; Immunoblastic Lymphadenopathy ; Korea* ; Lymphoma* ; Lymphoma, B-Cell ; Lymphoma, Follicular ; Lymphoma, Large-Cell, Anaplastic ; Lymphoma, T-Cell ; Lymphoma, T-Cell, Peripheral ; Pathology ; Retrospective Studies

BACKGROUND: Malignant melanoma in Korea has been increasing as in other countries, but there is no nationwide survey of malignant melanoma in Korea. OBJECTIVE: The aim of this study was to document the clinical and histopathological features of cutaneous melanoma in Korea. METHODS: The Dermatopathology Research Group conducted a review of nationwide collection of 109 primary cutaneous melanomas, diagnosed at 23 institutes over a recent 3-year period. Clinical records and pathology slides of the patients were reviewed retrospectively. RESULTS AND CONCLUSION: The peak age was the 7th decade with the mean age of 58.1 years. Korea has a higher rate of acral melanoma and much lower rate of lentigo maligna melanoma. .Major component tumor cell was spindle cell type. Clark level of tumor was III or more and Breslow depth was 2mm or more at the time of the first diagnosis in many cases (62%). Pre-existing melanocytic nevus was present in a few cases (3 cases). All these features suggest that the racial difference between the Korean and the Caucasian is evident. We also suggest that an early detection program is very important to cure this malignant tumor.
Academies and Institutes ; Diagnosis ; Humans ; Hutchinson's Melanotic Freckle ; Korea* ; Melanoma* ; Nevus, Pigmented ; Pathology ; Retrospective Studies

PURPOSE: A new method has been devised to determine contact pressures in prosthetic components. A real time analysis of the contact pressure distribution could help fine tuned implant positioning and ligament balancing during Total Knee Arthroplasty. MATERIALS AND METHODS: Posterior cruciate reserving type procedures were done with externally rotated femoral cut. Femorotibial contact pressure was measured in four compartments in both flexion and extension position. A LOAD CELL located beneath the tibial plate changes the contact pressure into electric signal and DP-41S transformed the electric sign into the pressure unit. Adjunctive fine-tuning operation was done to approximate the equilibrium among the four compartments of the tibial plate. RESULTS: Femorotibial contact pressure were distributed between 17.1 N (Newton) to 33.4 N (average 23.6 N). A peak contact pressure was exhibited in the anteromedial compartment in extended knee and in the posterolateral compartment in flexed knee. CONCLUSION: A LOAD CELL electronic transducer technique was introduced. This method was tried to get the balanced equilibrium of contact pressure between Femorotibial components during TKA.
Arthroplasty* ; Knee* ; Ligaments ; Transducers